The following description is provided to assist the understanding of the reader. None of the information provided or references cited is admitted to be prior art.
End stage renal disease (ESRD) is the manifestation of a chronic kidney disease characterized by complete kidney failure or an imminent progression thereto. There are a number of treatments for ESRD including hemodialysis, peritoneal dialysis, and kidney transplantation. Hemodialysis, however, is the primary therapy for patients with ESRD. Approximately seventy percent of ESRD patients require chronic, maintenance hemodialysis (MHD). The aim of MHD treatment is to replace kidney function with long-term hemodialysis intervention. MHD decreases nephrological degradation by removing contaminants from the blood and maintaining appropriate blood volume. Hemodialysis is performed by using a dialysis machine that pumps blood from a patient, through a dialyzer, and then back into the patient. Accordingly, hemodialysis therapy is an extracorporeal process that cleanses a patient's blood.
The number of maintenance dialysis patients in the United States is currently over 400,000 and still growing fast. Two thirds of all dialysis patients die within 5 years of initiation of dialysis treatment, a 5-year survival worse than that of many cancers. Approximately half of all dialysis patients die of cardiovascular disease (CVD). In the general population conventional serum levels of LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) predict incident atherosclerotic CVD. Nevertheless, similar to individuals with chronic heart failure (CHF), the conventional CVD risk factors such as hypercholesterolemia are not associated with mortality in these patients; indeed in both dialysis and CHF patients, a low, rather than a high, serum total cholesterol (TC) or LDL-C is associated with higher mortality, a phenomenon known as lipid paradox or reverse epidemiology. Hence, alternative CVD biomarkers including alternative lipid measures are needed to more reliably risk-stratify dialysis or CHF patients.
Each lipoprotein class consists of a continuous spectrum of particles of different size, density, metabolism, and atherogenic impact. Various studies have evaluated the associations of small LDL subfraction concentration, total LDL particle concentration (LDL-Pc), specific HDL subfractions, and combined measures such as the LDL-C/HDL-C and apoB/apoA-I ratios with cardiovascular risk. However studies on chronic kidney disease (CKD) patients are scarce and often limited to conventionally measured TC and LDL-C.